EVIDENCE BASED CARE

IN MY OFFICE at AMA (NSW) for the past 19 years there has been a framed cover of NSW Doctor. The headline on the cover says, “Who will be left holding the baby” and the photo is of a very cute, very new baby. The baby is my now 19-yearold son Tom as a literal newborn. The story was about midwife led obstetric units, two of which had just opened in NSW, one at Ryde and one at Belmont.

Fiona Davies CEO, AMA (NSW)

I have been thinking a lot about that cover because at the moment, it feels like the NSW hospital system has been dramatically catapulted back to the early 2000s, complete with the vitriol and of course, the revisiting of the greatest hits of battles around task substitution and birthing.

Those who lived through the early 2000s in the NSW hospital system will remember it was not great. It was routine for people to assume that is was not safe to get healthcare in NSW hospitals.

Following the AMA’s concerns about the establishment of 2 stand-alone midwife led obstetric units, the then Minister for Health asked us to visit them, which I did along with then President John Gullotta and obstetrician Andrew Pesce. My vivid recollection of the trip was being informed that a water birth was not “underwater” it was through water. I nodded politely.

We are incredibly fortune in Australia and NSW to have some of the best outcome measures for obstetrics in the world. Like all successful public health measures, this results in an expectation that having a baby will conform to the expectations we have for the rest of our life - an Instagram worthy moment where the birth plan is followed, and we all live happily ever after. Those working in obstetrics know this is not always the case.

While we should always be looking to improve our healthcare system, NSW has an excellent, women-centred model of healthcare. We know that in regional and rural areas, this model is struggling due to lack of workforce, and we need to look at this.

However, we need to consider models of obstetric care based on evidence, not emotion. We need to be mindful of the outcomes of the Ockenden review in the UK which demonstrated the terrible tragedy that comes when we don’t build healthcare models which place the health of the mother and the baby at the centre. We need to avoid the rush for the sake of change in this most critical of policy areas. dr.

Dominique Egan is the Workplace Relations Director and In-House Legal Counsel at AMA (NSW). She sat down with Rahni Sadler to discuss the variety of ways that she and her team of lawyers, paralegals and HR advisors are here to help.

WE’VE GOT YOU COVERED

In more ways than you probably know.

QYou made the switch from partner in a major law firm to the AMA (NSW) nearly four years ago. What inspired the move?

In my early days as a lawyer I was fortunate to complete a secondment at AMA (NSW). My time with the AMA taught me so much about the health system and medical practitioners and instilled in me a desire to support the medical profession in my legal practice. It was a great place to learn to just talk to people and develop those skills of empathy. It inspired my entire career focus so it feels right that I’ve brought all the skills I learned in private legal practice back to the place it all began.

QDescribe some of the skills you bring.

In my 20 years in private legal practice, I acted predominantly for medical practitioners, medical associations (including AMA (NSW)), medical defence organisations, and of course their members.

I had a varied practice all of which was medical practitioner focussed. I worked on professional conduct (disciplinary) claims made against medical practitioners before NCAT and the Medical Council of NSW, investigations conducted by the HCCC; employment and industrial matters including Visiting Medical Officer disputes in the public hospital system and Visiting Practitioner disputes in the private hospital system, unfair dismissal claims in the NSW Industrial Relations Commission and Fair Work Commission; workplace investigations and mediations; administrative law including judicial review proceedings, Medicare investigations and Professional Services Review for health professionals; commercial matters including advertising regulation, restraints of trade, privacy, corporate governance and competition and consumer laws; business structures and contracting arrangements for medical practices.

QAt AMA (NSW) what does the workplace relations team cover?

We have a team of HR professionals, legal practitioners and paralegals. AMA (NSW) is the registered industrial body for VMOs in the public hospital system, so we do a lot of work with individuals on their issues in hospitals, but also a lot of negotiations with Local Health

Districts and the Ministry of Health about those arrangements.

We provide individual support and assistance to Staff Specialists and Doctors-In-Training in the hospital system. We help members in private practice, with everything from recruiting to terminating staff including unfair dismissal claims and everything in between.

In terms of doctors in the hospital system, we support them in the public and the private hospital systems. We also provide medico-legal advice to medical practitioners predominantly in private practice but also there’ll be medico-legal issues that arise in the hospital system, so we provide that advice to members as well.

QYour team offers help with matters big and small. What are some of the things that members would be surprised to know are available to them?

I think probably the extent of the services that we do offer which are included as part of membership. For example, the extent to which we will help members with workplace disputes and investigations. We can help people prepare their responses, accompany them to meetings and support them through very difficult and stressful times.

In the private practice space we can come out and meet with practices and really help them get everything in order, to do an audit - not in a negative sensebut to go through what they’ve got in place and what might be some improvements they can make, and I think many members are surprised that we support and represent members through the unfair dismissal conciliation process.

QWhat are some specific examples?

Doctors in a hospital setting might be asked to attend meetings for a whole host of different reasons but one might be to respond to concerns raised about their behaviour. They might be asked to participate in an interview as a witness to something that has happened at the hospital, or they might be invited to have an informal discussion about something that may not be a serious matter but could become one.

People often think they might get the hospital offside if they bring an AMA support person to a less formal meeting. More often than not, hospitals are actually quite happy for us to come along because our role is not to advocate, but to be supportive, to help the member hear what’s being said to them. That might sound simple, but it’s human nature for people to walk away from a stressful interaction perhaps with a slightly different recollection, or to focus on a particular aspect of the meeting and possibly miss some other messages that were being conveyed.

Often, particularly for more difficult matters, the feedback I get from hospital administration is “We were really glad that you came along because we now know that that doctor is being looked after and being supported.”

QFrom a workplace relations standpoint, what do you think are the greatest stressors on doctors?

I think all health professionals postpandemic are still very tired. I think we’re still seeing the stress from that in the system.

The challenges of getting people to work and stay in regional areas is a real stress for those working in that space.

I think there needs to be a re-examination of the current industrial arrangements for VMOs, Staff Specialists and doctors-in-training so that those arrangements reflect modern expectations and current medical practice.

QHow are you able to assist in that?

At the moment we’re in negotiations with the Ministry of Health in relation to the Fee-forService VMO determination. Soon we will turn our attention to the sessional arrangements as well. Particularly we’re advocating for a change to allow VMOs who provide services remotely to be paid for doing so. We want doctors to have the opportunity to work in different ways, to be more productive, for patients to benefit but at the same time it’s vital that VMOs are properly remunerated.

Currently the system doesn’t recognise that there have been advances in technology that mean consultants can access medical records and test results remotely. They can have really meaningful engagement with other staff in the hospital and perhaps even with patients over video conference and make meaningful clinical decisions which mean they don’t have to come into the hospital in the middle of the night. They can make decisions about whether they should operate or not without bringing everyone into the theatre only to say, “Actually we’re not going ahead.” A lot of VMOs are already doing that but they’re not paid for it. It is something that’s in place in the ACT for VMOs and should be in NSW.

That’s probably the biggest change that we’re advocating for but there are always other things that can be improved so we’re also advocating for those.

QWhat’s your final message to members.

One thing I’d like to say to members is to remember to always pick up the phone.

Even if you think it’s something you think we can’t help with, call us, we probably can. If we can’t, we can connect you with people in the industry or service providers who can.

It’s really important to get support. Don’t become isolated because you think you’ve got an issue that you don’t want to tell anybody else. We provide a confidential service. We will not contact any third party without your consent.

That’s the benefit of the AMA membership – you’re never alone. Make sure you get in contact, and we can support you through it. I think you’ll be surprised at just how much help we can provide. dr.

You can contact Dominique and her team by emailing workplace@amansw.com.au or calling (02) 9439 8822 . We can make a time to chat in or out of working hours.